Insulin resistance in type 1 diabetes is a key modulator of platelet hyperreactivity – published online 30/04/2025

Rebecca C. Sagar, Daisie M. Yates, Sam M. Pearson, Noppadol Kietsiriroje, Matthew S. Hindle, Lih T. Cheah, Beth A. Webb, Ramzi A. Ajjan, Khalid M. Naseem

Individuals with type 1 diabetes are known to have an increased and premature onset of cardiovascular risk. The exact contribution of platelet-driven pathways to a prothrombotic environment is not completely understood. In this issue, Sagar et al (https://doi.org/10.1007/s00125-025-06429-z), with the use of multiparameter flow cytometry and machine-learning population tools, report data demonstrating a maladaptive phenotype in young individuals with type 1 diabetes. Compared with healthy control participants, individuals with type 1 diabetes were shown to have elevated markers of platelet activity under basal conditions, with an enhanced response to agonist stimulation along with a converse diminished response to inhibition with prostacyclin. This prothrombotic phenotype appeared to be further enhanced in those individuals with evidence of coexisting insulin resistance, measured through estimated glucose disposal rate (eGDR). The authors conclude that these data support the use of a proactive, personalised approach to stratifying and managing insulin resistance in such individuals.

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